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Pharmacy Prior Authorization

Pharmacy PA Contacts

Toll-free: 877-537-0722
Fax: 877-537-0720

Mississippi Medicaid Prescribers

Registered Users
If you are a Mississippi Medicaid prescriber, submit your prior authorization requests through the Envision web portal for the most efficient processing.

At 4:00 PM CST September 30, 2016, submit your prior authorization requests through the Change Healthcare provider portal.

Those Without Web Portal Access
For Mississippi Medicaid prescribers who are unable to submit prior authorizations through the Envision web portal, fax your request to:

Change Healthcare MS Medicaid Pharmacy PA Unit
Fax: 877-537-0720

Drug Prior Authorization Forms

Manual Prior Authorization Criteria

Pharmacy Prior Authorization – Other Information and Forms

PA Criteria Archive